Role of Tensor Fascia Lata Musculocutaneous Flap in Lymphedema of the Lower Extremity and External Genitalia

Abstract

The tensor fascia lata (TFL) musculocutaneous flap has been used to cover raw areas resulting after block dissection of fungating cancerous glands in the groin. Postoperative lymphorrhea, a frequent serious problem after groin block dissection, was not seen. It was inferred that the TFL musculocutaneous flap absorbed lymph. This observation was used in treating patients with lymphedema of the lower extremity and genitalia. Groin block dissection was performed in 12 patients with tubercular and filarial lymphedema. By performing a groin block dissection, lymph was allowed to escape in the area of dissection and the TFL musculocutaneous flap absorbed the lymph. As a result a consistent reduction in the size and edema of the affected areas was noted. Wrinkling and suppleness of skin was seen in each patient within the first week. In 1 patient with congenital lymphedema, edema was restricted to the leg and foot. In this patient, groin block dissection was not performed. One end of the TFL musculocutaneous flap was transferred to the calf, and in second stage the proximal end with the whole flap was transferred to the back of the thigh and popliteal fossa. The TFL musculocutaneous flap here acted as a bridge between the area of congenital lymphedema (leg) and the area with normal lymphatic drainage (thigh).